Physicians who behave unprofessionally toward other health care workers compromise both safety culture and patient health. Hostile behavior among surgeons is particularly harmful because surgical care is both teamwork-dependent and has high stakes. Although many have reported anecdotally that disrespectful surgeon behavior has led to patient harm, it is challenging to study systematically. Investigators sought to determine whether patients whose surgeons had coworker reports of unprofessional behavior experienced more harm. Surgeons at two academic medical centers who had coworker reports of unprofessional behavior in the 3 years before a surgery were more likely to have patients experience both medical and surgical complications after the surgery. These findings highlight the importance of empowering team members to report unprofessional behavior so that it can be remediated. Two WebM&M commentaries describe different approaches to addressing unprofessional physician behavior.

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Silence and poor communication are known threats to patient safety. In this simulation study, medical students were more likely to speak up if they noticed an error when paired with an attending surgeon who used encouraging rather than dismissive language.

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While surgical attending physicians reported encouraging residents to question their intraoperative decisions, only slightly more than half of the residents in this survey agreed. The authority gradient has been implicated in prior studies that also documented suboptimal communication in the operating room.

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Unprofessional behavior by clinicians poses definite patient safety threats, but most research in this area has focused on identifying and addressing disruptive behavior in the work environment. This randomized study raises the concern that physician behaviors outside of work can impair work performance. Significant worsening of simulated surgical performance was found when subjects (students and attending physicians) drank alcohol until intoxication the night before performing procedures. The authors of this study recommend that consideration be given to establishing formal recommendations for alcohol consumption prior to operating room duties. Lack of sleep prior to performing surgery has also been associated with surgical complications, and in fact, intoxication and sleep deprivation have been shown to have similar detrimental effects on physicians' cognitive performance.

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Teamwork training programs continue to emerge despite past reviews suggesting their mixed effectiveness in changing behavior. This study conducted a multilevel evaluation of the TeamSTEPPS training program within an operating room service line and used a comparison unit at a separate facility. Following a 4-hour didactic program, the trained group demonstrated increases in the quantity and quality of presurgical procedure briefings and the use of teamwork behaviors observed during cases. Similar to past efforts, increases were also noted in perceptions of safety culture and teamwork attitudes. This study adds to the literature by employing a multilevel evaluation strategy, using a comparison unit, and observing actual behavior change that was attributed to the training. Patient outcomes were not part of the measurement strategy.

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Duty-hour restrictions for resident physicians are intended to improve safety, but research in residents, nurses, and primary care physicians indicates that burnout and depression may be stronger predictors of substandard care than the number of hours worked. This survey of practicing surgeons revealed that 1 in 11 had committed a serious medical error within the past 3 months, and those who had committed an error were much more likely to meet criteria for burnout or depression. As in prior studies of surgeons, work hours were not correlated with likelihood of reporting an error, or being depressed. Although this survey could not determine if surgeons experienced emotional problems because of having committed an error or vice versa, it is well known that clinicians who commit errors experience substantial emotional distress, as discussed in an AHRQ WebM&M commentary.

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Incident reporting (IR) systems continue to consume tremendous energy for providers who submit incidents and for hospital safety leaders who analyze them. Despite the noted limitations in IR and the poor correlation to actual quality- or safety-related data, efforts to engage providers in IR focus on building a positive safety culture. This study surveyed nurses and physicians about their reporting practices and found that nurses were more aware of existing IR systems, while the level of harm, incident type, and profession all influenced the likelihood of reporting. Of note, physicians were less likely to report surgical complications compared to other incident types as these were more frequently discussed in morbidity and mortality conferences.